STORY ARCHIVE

Taming the Problem Child

Catalyst presents a controversial documentary from the BBC. ‘Taming the Problem Child’, tests a ‘spare the rod, spoil the child’ treatment for uncontrollable youngsters.

Haley is five years old, mildly autistic and out of control. She’s one of a growing number of children with severe aggressive behavioural disorders. One minute she is hugging her mother, but seconds later she is biting and punching her. Her aggression towards other children has put her on the verge of being withdrawn from school and her parents are desperate.

Sergei is 12 years old. He is withdrawn, depressed and violent. He was found wandering the streets of St Petersburg at the age of five. Nobody knows what happened to him in those first five years. He was put into a Russian orphanage until he was adopted three years later by an American family. But the only interaction he has with his new family is through rage and physical attacks on his adoptive mother. As with Haley, no treatment, doctor or psychologist has been able to help… until now.

Dr Ron Federici is an American neuro-psychologist who specialises in working with institutionalised children (he has spent a good deal of time in orphanages in Eastern Europe, and has fostered seven of the orphans himself). Federici believes that what disturbed children need most are rules, structure, and a sense of order imposed on confused emotions and he has devised a treatment plan for even the most extreme cases of conduct-disordered children. He claims it is suitable no matter whether their behaviour lies in neurological or psychological problems and that it guarantees two things: firstly, that there will be an 80% rate of improvement in most children; and secondly, that neither the parents nor the children will enjoy the process – quite the opposite, in fact.

For at least 30 days, the child must stay within three feet of its parents, 24 hours a day. They have to be totally compliant to whatever their parents want and if they refuse to obey they are forced down onto the floor and held there. Their bedrooms are stripped bare; they are never left alone, nor allowed to see friends. Then, through a gradual process of reward and punishment, the child will eventually be reintroduced to their toys, their peers and the outside world. The treatment can last for months.

Horizon follows the families as they start to implement the treatment programme under the supervision of Dr Federici himself. He claims this is the only way the child can progress to developing normal emotions. His critics believe this process may be damaging. Thousands of American families are already keen to begin the programme, but does it really work and should it be applied?

TRANSCRIPT

CHARLIE MORTON: When he comes into the room he wants what he wants now and if he doesn’t get it he’s liable to attack you. He’s 12 years old and the kids that did Columbine and shot those people in the school at 14 or 15 and I’m not saying that that’s where he’s going to end up, but if you ask me could it happen I’d have to say yes.

(HAYLEY KEW’S TANTRUM)

JULIE KEW: People have said to us it, it’s a phase, she’ll grow out of it, but she’s been like it since she was 4 months old. She’ll, she won’t grow out of it.

(TANTRUM CONT’D)

NARRATOR (ADEN GILLETT): Coping with children with severe behavioural disorders is becoming a widespread issue. These parents are now forced to live with their children's increasing aggression and violence. It's a complex problem with no easy answers. Now one man is offering an extreme solution, but it requires parents to go against their deepest instincts.

DR. RON FEDERICI: There is a solution. The solution lies within the family. It’s difficult for the parents to hear but parents have to be able to give up what they believe is the right way to parent their child.

GLORIA MORTON: There’s just a lot of anger, a lot of contempt for people, a lot of hate.

NARRATOR: Sergei was found at five years old on the streets of St. Petersburg. Very little is known about his childhood, but it was clearly traumatic. He was adopted by the Morton’s from a Russian orphanage four years ago when he was eight. The Morton’s have adopted two other Russian children, but they behave nothing like Sergei. His adoptive parents say that he is depressed, violent, that he hates being near them and isolates himself.

GLORIA MORTON: Can you calm down just a little SERGEI MORTON: Shut up.

CHARLIE MORTON: When we were coming home from a dinner one night he attacked both his brothers, tried to choke his younger brother and even attacked his big sister. Now how much more violent is he going to be than he is now, when he’s stronger and bigger and maybe find a gun some place. Are you done? You don’t want to sit and talk?

SERGEI MORTON: No.

NARRATOR: His mother is frightened of him. His father, not wanting to physically fight with Sergei, no longer confronts him. The parents assumed that his troubled childhood was the cause and sent him to psychotherapy for 4 years. However they feel it changed nothing. Sergei is getting more violent.

INTERVIEWER: Do you understand why your Mum and Dad get upset with you sometimes?

SERGEI MORTON: Yes.

INTERVIEWER: Why do you think that is?

SERGEI MORTON: ‘Cos I’m nasty to people.

(HAYLEY KEW’S TANTRUM)

IAN KEW: She’s a lovely little child, but has an explosive behavioural problem.

JULIE KEW: She comes up to you and, and she says I love you Mummy. She gets hold of you and she gives you a squeeze and then it’ll turn to a pinch or she’ll headbutt you.

IAN KEW: The progression, it’s just been steady.

NARRATOR: Hayley is nearly 6 years old. She rages half a dozen times a day without provocation. She regularly attacks her mother, punching and biting her for no reason. Because her aggression has extended to attacking other children, Hayley has now been excluded from the school playground.

JULIE KEW: I went in the first day and I was with her and while I was there she’d turned round and bitten the little girl next to her and poked her eye.

(HAYLEY KEW’S TANTRUM)

NARRATOR: Hayley has been diagnosed with learning disabilities and a mild form of autism. This tends to make her inflexible and hyperactive. Her parents have sought help from many doctors, but none has offered the hope that he behaviour could really change.

From his Washington practice Dr. Federici claims an 80% success rate in his treatment of thousands of children in America suffering from what he believes are attachment disorders. His treatment is totally surprising. Where conventional psychology would emphasise love and understanding he insists the answer is not love.

RON FEDERICI: So often families feel that the best intervention they can give is unconditional love, affection, patience, time and talking to their child and that turns out to be the incorrect mode of dealing with the child.

NARRATOR: Dr. Federici’s treatment means reversing the normal rules of parenting. He believes the starting point is not love, but control, that through the parents almost military control these children will grow to trust, feel secure and ultimately attach, but will it work? Hayley and Sergei have now been diagnosed by Dr. Federici as having attachment problems and are about to start this radical treatment.

NARRATOR: The first stage of the treatment plan starts at level 1.Sergei will be confined with his parents for at least 4 weeks. He must stay within 3ft of them 24 hours a day. They will be his sole influence.

RON FEDERICI: Yes sir, I will. Your Mom and Dad are in charge of everything, meaning that you have to ask for permission. Excuse me, may I go to the bathroom? Excuse me, may I read a book? The answer is no unless your father says Serge, you can read a book with me. You cannot do anything alone. He cannot do anything alone because he likes to run away and if he runs to his room, take the doors off.

NARRATOR: The next step is to take away Sergei’s world and replace it with that of his parents. From now on they will be his life, they will even sleep here in his room. Everything else will be removed.

NARRATOR: Charlie is trying out the 3ft rule. He must continually monitor and instruct Sergei on how to behave well. Controversially for a child treatment programme there is no school, no peer activities, no privacy. Three acts of disobedience and an extra day is added to the programme.

NARRATOR: Dr. Federici believes that Sergei barely has an identity and that a new one must be imposed.

RON FEDERICI: Critics may say that to control a child’s every movement in time and space is taking away his identity. Well we’ve established very clearly that he doesn’t have an identity and he’s an empty slate and what we are providing is not a control really per say, but a management and a structural modification of his day-to-day, hour-to-hour routine so he does not deviate and it may be dictated by the parents, but it has to be because left to his own devices he’s random and confused. He needs to be dismantled and taken apart.

PROF PETER FONAGY: I’ve major worries about this notion of knocking things down in order to build them up. The normal approach to cheating behavioural disorder of this kind is to help the parents understand the child better. What is so vulnerable in these children is their sense of themselves, their sense of who they are. Now if you are systematically undermining that very fragile, that very vulnerable sense of who that child is you could end up in the situation where the child becomes really very much more depressed and hopeless and helpless.

NARRATOR: Dr. Federici has an international reputation for working with institutionalised children and it is through his work with these children that he developed his unusual treatment plan.

RON FEDERICI: Most of my experience has been working with very damaged children in institutional settings in Eastern Europe such as Romania and also within the United States, seeing many children abused, neglected and severely deprived.

NARRATOR: From what he has learnt in these orphanages Dr. Federici has come to believe that many child behavioural problems stem from a lack of attachment and he has now developed a theory about how to help all unattached children, no matter what the cause of their problem. He now applies his theory beyond the orphanage to children who have failed to attach, for whatever reason, even to those brought up in ordinary homes.

HAYLEY KEW: I want to make you well.

JULIE KEW: So what are you doing then?

NARRATOR: Desperate for a solution, the Kew’s have also turned to Dr. Federici. He’s aware of Hayley’s autistic traits and believes they have inhibited her attachment to her parents. To put the parents in control Dr. Federici believes Hayley must learn to obey every instruction. Her parents must no longer negotiate, but dictate to her.

RON FEDERICI: So if we talk about breaking Hayley down, which she will not like, you have to maintain a boundary with Hayley and that you have to take a break on hugging her and letting her sit on your lap. Be a bit detached and watch the I love yous, the pleasantries, the honeys. She uses that to reinforce her bad behaviours. OK, Dad, if you were to practice right now and say Hayley, you will sit on the couch now and if she does not you pick her up and sit her on the couch.

IAN KEW: I mean I’d tell her, but she wouldn’t do it.

RON FEDERICI: I understand that (TALKING TOGETHER)

IAN KEW: Hayley, you go and sit on the couch over there.

HAYLEY KEW: I don’t really.

RON FEDERICI: See we have a problem. If you would do that now.

IAN KEW: Hayley, go and sit on the couch.

HAYLEY KEW: No, no, I want Mummy, (REPEATS THIS MANY TIMES)

RON FEDERICI: Just the way she should be. (TANTRUM CONT’D) It’s very painful for you to watch. (TANTRUM CONT’D)

NARRATOR: Dr. Federici believes a child will only learn to comply when it realises its parents are dominant. Controversially, Hayley is to be placed face down in a hold every time she disobeys. When she is calm she is to be comforted.

RON FEDERICI: She will have to learn and Mom will have to have her hands on here, so Hayley has some control from both parents. She could not transition from sitting on your lap to a simple order of sit on the couch. Give her an order to sit up on the couch and she…

IAN KEW: Hayley, sit up on the couch darling.

RON FEDERICI: No, no darling. Just sit up on the couch.

IAN KEW: Hayley, sit up.

JULIE KEW: Hayley, sit up.

IAN KEW: Sit up.

DR. F: Sit up on the couch.

DR. STEPHEN SCOTT: I can see the attraction for a very frustrated parent with a child who’s being very aggressive, kicking and spitting, that you do indeed need to get control and certainly I would agree one needs to have firm boundaries but not an arbitrary set of boundaries, so just to say I want to see you to sit over there for no apparent reason and to have instant obedience to that it’s not something they usually do and the child can’t see a reason for it.

RON FEDERICI: Did Hayley go sit on the couch? Say yes. Say yes.

HAYLEY KEW: Yes.

RON FEDERICI: Are you tired? Say I am tired.

HAYLEY KEW: I’m tired.

RON FEDERICI: Yes you are tired. Very good girl, very good girl. You’re tired.

NARRATOR: A sequence one hold will be used with Sergei, as with Hayley, to put the parents in control.

RON FEDERICI: I just want to show you something. There’s no problem now because you’re not fighting or being angry, so I’m showing you I’m not going to hurt you. We would never ever, ever hurt you, never, but you can never hurt us because the most important thing is to go down. You can go down, go down.

SERGEI MORTON: I have to?

RON FEDERICI: Yes. Down.

SERGEI MORTON: OK OK

RON FEDERICI: Down, down, lay down. You do anything violent, Mom and Dad will take you down to get you in control. There will never be fights. If he tries he goes down. He goes down for hitting, kicking, spitting, cussing in your face, screaming, breaking property, slamming doors. Where he’s out of control he must go down immediately. Now how do you feel Serge? Do you like this?

SERGEI MORTON: No!

RON FEDERICI: Not bad huh.

SERGEI MORTON: I said no.

RON FEDERICI: No, OK.

SERGEI MORTON: Can you get off me now?

RON FEDERICI: No.

SERGEI MORTON: Guys.

RON FEDERICI: There’s not being hurt.

SERGEI MORTON: No my toe is twisted. It still hurts from a long time ago.

RON FEDERICI: He may choose to make up all kinds of stories.

SERGEI MORTON: It’s not, I’m not making it up.

RON FEDERICI: He’s very angry.

SERGEI MORTON: I’m not making it up.

RON FEDERICI: Once he was down I think he felt, it was the first time I’d seen the boy cry at that level. The parents said they’d never seen him cry those type of tears. He didn’t complain of being hurt aside from some ridiculous statement that his toe was hurt and there was no pressure, there was no force, there was nothing dangerous. I think he felt safe for the first time and also that his parents cared enough for him to be on top and in charge of him because he’s not in charge of himself.

SERGEI MORTON: Mom, you can let one arm…

NARRATOR: Most psychologists only accept the use of restraint in the most extreme circumstances. They would not accept that a child would find the hold reassuring.

RON FEDERICI:..and Serge, don’t move.

PETER FONAGY: I think there’s a real danger in assuming that we know what’s going on in the child’s mind. How do we know that that child is going to interpret two parents trying to physically restrain him as an act of affection.

NARRATOR: The Kews are 2 weeks into the programme.Both parents have taken time off work. Hayley’s room has been stripped.

JULIE KEW: Let me show youfirst. Let go.

NARRATOR: She’s been taken out of school. Her world is her parents and they must be emotionally distant.

JULIE KEW: We have to try and be aloof from herwhich I’m finding very difficult.

JULIE KEW: She has no toys, she, she doesn’t see any friends, she does no activities. We have to control her singing and her talking because when she does these things she’s actually in her own world where she has to be in our world and she finds that very difficult.

HAYLEY KEW: (INAUDIBLE REMARK)

IAN KEW: Let go.

HAYLEY KEW: I want it, I want it, I want it.

NARRATOR: When Hayley disobeys her parents are instructed to put her in a sequence 1 hold. This is happening several times a day.

(HAYLEY KEW’S TANTRUM)

IAN KEW: I mean you know you’re taught to love your child, hold your child, kiss her, cuddle her, give her all the support possible and this totally throws that out the window.

JULIE KEW: Are we destroying her? I want a better behaved Hayley, I don’t want a different Hayley.

STEPHEN SCOTT: My worry about such a severe approach is that it is actually at risk of being quite punitive, of frightening the child and of just repressing their behaviour so the kind of child this is bringing about is one who is instantaneously obedient, who doesn’t start thinking for themselves and doesn’t start adapting to their environment.

NARRATOR: Dr. Federici is still at the Mortons. Today he will teach them a new technique, a sequence 2 hold.This requires Sergei to sit on his parents lap to learn about closeness and attachment. Sergei will find it hard as he has not let his mother embrace him for over a year.

RON FEDERICI: Eyes, only eyes, only eyes. Stand up.

NARRATOR: Dr. Federici believes Sergei can be taught how to feel and understand emotion by looking at his parents facial expressions and feeling their embrace.

RON FEDERICI: Is he looking at you Mom, or looking around you?

GLORIA MORTON: He’s looking at me.

RON FEDERICI: OK, good. This is a lot better for him than being on his own. This, this is much more positive than fighting with you. Is he still looking?

GLORIA MORTON: Yes he’s wandering a little.

RON FEDERICI: What they’re learning basically is a new language called emotions. They may have learned English, they may have learned another language, but the new language of emotion is one of the ones that’s the most important they will learn by practice.

GLORIA MORTON: I’m very proud of you when you do that.

STEPHEN SCOTT: They’re not re-writeable like some computer disc. Nearly all children who are behaving anti-socially do have a full range of emotion, they do understand happiness and sadness, so the notion that they’re all scrabbled up inside and you’ve got to cut through all that, I think is a mistaken one. I think it’s about reshaping and re-directing their emotions.

NARRATOR: Dr. Federici would disagree. He has now left the Morton’s and the treatment is in their hands.

GLORIA MORTON: I was surprised at the look of fear on his face when he sat on our lap, that he didn’t know what we were going to do.

CHARLIE MORTON: I don’t think it’s going to be easy, but it’s step by step. I mean he’s even reverted already. He’s telling us what to do and, and the doctor hasn’t been gone, what, two hours, so we can expect that.

GLORIA MORTON: Cut that streak.

SERGEI MORTON: What? (INAUDIBLE) the ground and it slipped.

GLORIA MORTON: (INAUDIBLE REMARK)

NARRATOR: Gloria decides to attempt a sequence two hold.

GLORIA MORTON: (INAUDIBLE REMARK) Turn around.

SERGEI MORTON: No.

GLORIA MORTON: Yeah, you’re doing it.

SERGEI MORTON: No.

GLORIA MORTON: Turn around. (TALKING TOGETHER)

SERGEI MORTON: …you’re doing this to me.

GLORIA MORTON: I’m just having you turn around.

SERGEI MORTON: Mom, your nails.

GLORIA MORTON: Put the car down, there, on the table. That’s the floor isn’t it? Is that the floor? What is it?

SERGEI MORTON: (ANGRY REMARK)

GLORIA MORTON: Come here, turn around.

PROF PETER FONAGY: If you are imposing proximity in the hope that you will impose attachment then you will quickly realise that that’s a paradox. Attachment is perhaps one of the only things in life that one cannot impose.

NARRATOR: The Kews are six weeks into the treatment. Hayley’s non-compliance has added another three weeks to level one. Nevertheless, her parents now feel she is showing an improvement.

JULIE KEW: I think, I think genuinely she has improved. She’s doing as she’s asked and very happy doing what she’s been asked to do as well.

NARRATOR: After four weeks Sergei is struggling on level one, but his parents believe they see some changes in his behaviour.

GLORIA MORTON: I, I don’t feel the, the threat to myself that I felt before. He would get very aggressive with me, pushing or hitting or shoving and I, I don’t feel that way now.

STEPHEN SCOTT: My concern of a total adherence programme of the kind of Dr. Federici’s is that the child may behave that way while they’re in the context with the parents, but phew, the minute their parents back are turned they’re going to resort to their old behaviour. They haven’t really internalised a better way of behaving and being.

GLORIA MORTON: I can’t hear any can I go or go…

SERGEI MORTON: Can I go please…

CHARLIE MORTON: There was just you were leaving.

SERGEI MORTON: Sure.

CHARLIE MORTON: Sure.

SERGEI MORTON: Thank goodness.

NARRATOR: After 4 months Hayley has started back at school away from her parents watch. If level 1 has been effective she should be able to control her behaviour outside the home. It’s a big test for Dr. Federici’s treatment.

JULIE KEW: Since she’s been back at school we still get the reports back that she’s hit somebody, she’s pushed somebody and that she’s bitten a child. I thought that maybe that she’d learnt, but obviously she hasn’t.

RON FEDERICI: Failures happen all the time. People go back to level 1 all the time if they violate the major rules which are resurgence of aggression, violence, lying, cheating and manipulation, because that gives the parents the message that the child needs even more time with them to help break down further barriers which have been left untouched because that means the child still has some deeper layers of problems.

NARRATOR: After 3 months Sergei’s parents report that he seems to have deteriorated and that his behaviour is almost as bad as before. they are continuing with the treatment. However, what concerns critics is that there have been no control trials to measure independently the effect of the treatment.

PETER FONAGY: Because it’s such an unusual intervention I would really want to know in a properly conducted randomised control trial that the treatment is (a) safe and (b) effective in the long run.

NARRATOR: Dr. Federici eventually plans to have control trials. Meanwhile he continues to gain a wider following of parents desperate for help and believes he can treat successfully even the most difficult cases.

RON FEDERICI: Even in the most difficult of situations where the child has been written off as being totally unattached and irrecuperable I believe very strongly that any child, even that level of damage, by hard work and very unorthodox and aggressive and innovative techniques will often bring that damaged child to an 80% solution with the family.